HEALTH CARE/Joan Retsinas

Digestive Rumba

Why is my stomach dancing a rumba? Why do my intestines mambo? Was it last nights lasagna? Am I suddenly lactose-intolerant? Did a bug drop from the chefs fingers onto my entrée Did the mice on the kitchen floor play a role? Did salmonella breed in the tepid dishwater?

We all have danced to the digestive rumba. Even foodies who have outfitted their home-kitchens with Aga stoves often eat out. For some Americans, eating in means take-out. Afterward, sometimes our stomachs have danced. Sometimes we have called a doctor, or sped to an emergency room.

And sometimes, if enough people fall sick, a public health department has rushed in, scouring the alleged culprit-restaurant for clues. A death or two will propel the story to the web. If implicated, the restaurant will apologize, reorganize, pay a fine, maybe close. An understaffed health department will promise greater vigilance, without promising to hire more inspectors.

Most of the time, though, patrons who blame something they ate for their digestive rumba wont know for sure; and eventually the malaise will pass, the rumba stop. And the restaurant will continue in the same modus operandi.

New York City recently intervened proactively to improve restaurants. (Michael Howard Saul, Wall Street Journal, March 7, 2012) Since July 2010, the city has investigated restaurants  not just a statistical sliver of them. It has sought to investigate all 24,000. Inspectors look for public health hazards (e.g., hot food kept cold, raw food not refrigerated), as well as sanitary violations (e.g., unwashed lettuce served in a salad, roaches in the kitchen). If a restaurant cannot correct a major hazard immediately, the city may close the restaurant. Otherwise, inspectors count the number of violations, weighing them by importance, to yield an A, B, or C grade. If a restaurant appeals a low grade, an inspector will make an unannounced visit to recheck.

The restaurants cost, reputation, and location have not necessarily correlated with grade. Expensive bistros have initially rated Bs; neighborhood delis, As. Violations spur fines: in the last year the city netted $42.4 million in fines  up from $17.6 million in 2006.

At the same time, patrons get a yardstick. Restaurants post their grades prominently at the entrance  not inconspicuously at the back. (Restaurants that do not post their grades risk a $1,000 fine.) Before walking through the door, the patron can decide: The charming bistro got great reviews on yelp, scored high on Zagat, and has a celebrity chef. It rated a B. Should I try it? A free application on a phone will let strollers check restaurants by location or name. One survey shows that 88% of New Yorkers consider the ratings when dining.

At a time of enthusiasm for less, or no, government, New York City demonstrates the value of a strong interventionist government, acting on behalf of the publics health. Restaurants are independent businesses; they have balked at the rating system, complained that inspectors are unfair, that the fines are onerous, that their businesses have suffered, that the city should leave them alone.

But the citys intervention has yielded measurable benefits. Thanks to the grading system, restaurants have improved. Consider mice, one criterion. Before the rating system, 32% of New York City restaurants had mice; afterward, 22%. Today 72% of restaurants post an A (some after initially getting a lower grade), up from 65% last year. And, in spite of restaurant owners dire warnings, their revenues have not fallen. As restaurants have improved, so have diners appetites: the city reports that restaurant revenue rose overall 9.3% after the ratings (though restaurants that post Cs complain of lower revenues).

Crucially, the publics health improved: cases of salmonella dropped in New York City  down 14%, the lowest rate in 20 years. Figuratively as well as literally, Justice Brandeis was right: sunlight is the best disinfectant; and New Yorks municipal government let the sun in.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.